Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men
Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men
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DOI：
10.7448/ias.19.3.20779
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发表时间：
2016-07-01
影响因子：
6
通讯作者：
Ayala, George
中科院分区：
文献类型：
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作者：
Scheim, Ayden I.;Santos, Glenn-Milo;Ayala, George
简介：免费或低成本的艾滋病毒检测、避孕套和润滑剂是基本的艾滋病毒预防策略，但男男性行为者(MSM)往往无法获得。在污名和缺乏医疗保健服务的全球背景下，跨性别男男性接触者在获得艾滋病毒预防服务方面可能面临更多障碍。根据全球MSM调查的数据，我们旨在描述跨性别性MSM对预防服务的感知获得情况，检查耻辱和获得之间的联系，并比较跨性别者和顺性(非变性人)MSM之间的获得。方法：2014年全球男性健康和权利在线调查对来自任何国家的MSM(包括跨性别者)开放，并有七种语言可用。基线数据(n=3857)收集自2014年7月至10月。在跨性MSM中，计算了感知的服务可获得性与反变性人暴力、医疗保健提供者污名和歧视之间的相关性。采用嵌套配对研究设计，将跨性别男男性接触者与顺性男男性接触者按年龄组、地区和HIV状况进行4：1配对，条件Logistic回归模型比较跨性别者对预防服务知觉的可及性。结果：约3.4%的受访者为跨性别者，其中69人进入本次分析。跨性MSM参与者的平均年龄为26至35岁(56.5%)；居住在西欧、北美或大洋洲(75.4%)；报告为HIV阴性(98.6%)。43.5%、53.6%和26.1%的跨性男男性接触者可获得HIV检测、安全套和润滑剂。在过去的六个月里，曾因变性人而被捕或被定罪，并更多地暴露在医疗保健提供者的耻辱之下，与获得一些预防服务的机会较少有关。与匹配的顺性对照相比，跨性男男性接触HIV检测(OR=0.57，95%CI=0.33，0.98)和避孕套兼容润滑剂(OR=0.54，95%CI=0.30，0.98)的几率显著降低。结论：首次调查全球跨性MSM获得HIV预防服务的情况发现，大多数跨性MSM缺乏基本的预防服务，他们获得HIV检测和润滑剂的可能性低于顺性MSM。结果表明，需要加强跨性男男性接触者获得基本艾滋病毒预防服务的机会，包括针对男男性接触者的服务。
Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-transgender) MSM.Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n = 3857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4: 1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status.Results: About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%); lived in western Europe, North America, or Oceania (75.4%); and reported being HIV-negative (98.6%). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR = 0.57, 95% CI = 0.33, 0.98) and condom-compatible lubricants (OR = 0.54, 95% CI = 0.30, 0.98).Conclusions: This first look at access to HIV prevention services for trans MSM globally found that most reported inadequate access to basic prevention services and that they were less likely than cisgender MSM to have access to HIV testing and lubricants. Results indicate the need to enhance access to basic HIV prevention services for trans MSM, including MSM-specific services.